Introduction

There is a lack of evidence-based treatments for patients with chronic pain after total knee arthroplasty (TKA). It is well-established that knee extensor and flexor muscle strength are markedly impaired following TKA, but no studies have examined muscle strength and power in patients with chronic pain after TKA. Therefore, the aim was to investigate if neuromuscular exercises and pain neuroscience education (PNE) were superior to PNE alone for improvement of muscle strength and power in patients with chronic pain after TKA.

Background and Purpose: The New Mobility Score (NMS)(score from 0–9)(1) is being used to evaluate the prefracture functional level and to predict for example mortality in hip fracture patients. Previous studies have found or used a cut-off point of the NMS at 5, but reliability data of the NMS score is currently missing. Reliability refers to the consistency of a test or measurement and it can be quantified as either relative or absolute reliability. Relative reliability is often expressed by the intraclass correlation coefficients (ICC), which indicate the relationship between 2 or more measures of the same score. Absolute reliability is often expressed by the standard error of measurement (SEM). SEM quantifies the precision of individual scores on a test and gives the clinician a result in the same unit as the measurement. The aim of the study was to assess the inter-tester reliability of the NMS in acute hip fracture patients, when obtained by physicians and physiotherapists.

Subjects: Forty eight consecutive hip fracture patients at a median age of 84 (IQR, 76–89) years admitted to a specialized orthopaedic hip fracture unit at a university hospital.

Methods: The NMS, that describes the prefracture functional level, is a composite score of the patient’s ability to perform: indoor walking, outdoor walking and shopping before the hip fracture, providing a score between zero and three (0: not at all, 1: with help from another person, 2: with an aid, 3: no difficulty) for each function, resulting in a total score from 0 to 9, with nine indicating a high prefracture functional level. The NMS was assessed by physicians at the acute ward on admission and by two independent physiotherapists at different postoperative days at the stationary orthopaedic ward. Also, age, mental status on admission and residential status was recorded. The relative reliability was calculated using the ICC 1.1, while the absolute reliability was calculated using the SEM.

Results: The inter-tester reliability was higher between the two physiotherapists at the stationary ward (ICC 0.98) and (SEM 0.42) (95%CI + 0.82) compared to, between physicians at the acute ward and both physiotherapists (ICC 0.87) and (SEM 1.05) (95%CI + 2.06). No systematic between-rater bias was observed (P > 0.05). Patients with different recorded scores were significantly older (P < 0.023) and had lower NMS-scores than those with equal recorded scores.

Conclusion: The relative and absolute reliability of the NMS, when used in acute hip fracture patients, is very high, especially when the score is recorded by physiotherapists at the stationary orthopaedic ward. Ward personal should be extra careful when recording the NMS in subjects with older age and lower NMS and mental scores.

Introduction: Single leg hop for distance is a test often used as a measure of knee performance and stability during rehabilitation after knee surgery or injury. Both distance hopped and qualitative assessment of stability in landing is widely used as parameters of knee joint control. While hop distance is reported as highly reliable, no investigations have studied the reliability of the biomechanical parameters expressing the quality of the landing after a single leg hop. The aim of the present study was to investigate the reliability of hop distance and biomechanical landing parameters during a single leg hop test.

Methods: The study was designed as an intra-tester, inter-day test-retest reliability study. Fourteen (7 males, 7 females) physically active, healthy subjects volunteered to participate. The subjects performed 5 maximal single leg hops for distance including 2 trial jumps, and the mean of the last 3 hops was used for analysis. The test session was repeated after 1 week. In both sessions the same tester placed markers on the lower body (Helen Hayes model) and the subjects landed after maximal hopping on a force plate. The hops were recorded using an 8 camera Vicon 612 system filming at 200 Hz. Kinematic and kinetic data were calculated using inherent Vicon software. Intraclass Correlation Coefficient (2,1) was used for analysis of reliability on selected kinematic and kinetic knee joint parameters.

Results: The ICC of the maximal hop distance was excellent (0.93, p< 0.001). The reliability of the maximal knee joint flexion during landing was poor and non-significant, and also peak knee extensor moment during landing showed poor reliability (ICC: 0.48, p=0.037). The maximal external knee joint varus moment and the relative eccentric power production of the knee joint in comparison to the hip and ankle joints were moderately reliable (ICC: 0.56, p=0.015, and ICC: 0.64, p=0.005, respectively).

Conclusions: This study shows, that in healthy subjects the reliability of the maximal hop distance is excellent, however the underlying biomechanical parameters controlling the knee joint during landing is only moderately or poorly reliable. This may imply, that the subjects use slightly different strategies during landing from the hop and evaluation of knee joint performance based on landing biomechanics may be done with caution. Future reliability and validation studies of the take-off biomechanics may further reveal if the single leg hop test is reliable and valid as a measure of knee joint performance.

Objectives: To investigate

if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared to healthy subjects,

Methods: Thirty subjects aged 20–32 yrs were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography. Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis.

Results: Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean ± 1 SD, 7.7 ± 3.1 mm) and medial longitudinal-arch deformation (5.9 ± 3.2 deg) during quiet standing compared to controls (5.0 ± 2.2 mm and 3.5 ± 2.6 deg, P < 0.05). Subjects with medial tibial stress syndrome also demonstrated significantly larger medial longitudinal-arch deformation (8.8 ± 1.8 deg) during gait compared to controls (7.1 ± 1.7 deg, P = 0.015). There was no correlation between medial longitudinal-arch deformation during quiet standing and gait in either of the two groups (r < 0.127, P > 0.653).

Conclusion: The subjects with medial tibial stress syndrome in this study demonstrated increased navicular drop and medial longitudinal-arch deformation during quiet standing and increased medial longitudinal-arch deformation during gait compared to healthy subjects. Medial longitudinal-arch deformation during quiet standing did not correlate with medial longitudinal-arch deformation during gait in either of the two groups.